[Platypnea-orthodeoxia revealed by recurrent syncope episodes]. / Platypnée-orthodéoxie révélée par des syncopes à répétition.

Platypnea-orthodeoxia is a rare clinical condition which must be examined as a differential diagnosis for any bout of faintness occurring during standing or dyspnea that is exacerbated by standing. This syndrome is often associated with a patent foramen ovale. Its physiopathology is not univocal and the association of many anatomical criteria seems to be mandatory. Contrast echocardiography confirms diagnosis and closure of the patent foramen ovale during interventional catheterization and is currently the therapeutic method of choice. After closure of the foramen ovale, clinical improvement is spectacular and durable.

[Percutaneous suture of femoral artery after diagnostic coronary angiography]. / Suture percutanée du point de ponction artériel fémoral après coronarographie diagnostique.

UNLABELLED: Complete local haemostasis after femoral artery catheterization can be performed using percutaneous suture devices. To evaluate efficacy and safety of these systems after diagnostic coronary angiography, we performed a randomized study where patients were treated either with a manual compression (group C) or a percutaneous suture (group T). Fifty patients were included in each group. Patients in group C had to rest at bed during 24 hours while patients in group T had to stand up and walk immediately after complete haemostasis was obtained. All angiographies were performed using a 6 F sheath. All patients had a clinical evaluation and an echography 24 hours after the procedure and all were reached by phone call at 15 days. Both groups were similar in term of age, sex ratio, diabetes, height and weight. Complete haemostasis was obtained in 20 +/- 6 mn in group C and in 6 +/- 10 mn in group T (p < 0.001). Device technical success rate in group T was 90%; 70% of patients walked immediately down the X ray table and 90% before the 4 hours. Ambulation delay was 24 +/- 5 hours in group C and 5 +/- 9 hours in group T (p < 0.0001). Clinical and echographic complications rate were similar in both groups (8%). There was no post procedure complication in group T (especially after ambulation) nor at the phone call. CONCLUSION: Femoral artery percutaneous suture after diagnostic coronary angiography is as safe and working than manual compression. It allows an immediate mobilization and ambulation, far earlier than compression.

[Physiology of coronary circulation and angioplasty: utopia or clinical reality?]. / La physiologie de la circulation coronaire et l'angioplastie: utopie ou réalité clinique?

Small pressure transducer and Doppler quartz placed at the tip of angioplasty guide wire give the opportunity to measure coronary flow physiology parameters, the physiopathologic impact of an epicardic coronary stenosis and the efficacy of its treatment. This gives the opportunity to over ride the coronary imaging limitations. Doppler and pressure investigate a different and complementary aspect of the pressure-flow relation and may be used together in some special cases. Myocardial fractional flow reserve (FFRmyo) and relative coronary reserve concepts allow to evaluate patients with heterogeneous coronary reserve. Clinical application field is very broad and can be applied to each step of coronary angioplasty from the evaluation of intermediate lesions and the indication of angioplasty to the guidance of the procedure to the evaluation of the result, through the stenting indication and the stent placement optimization. Numerous studies has emphasized the role of physiologic coronary assessment in the cathlab. The time and economic gain of such an attitude has to be confirmed by future trials but it is clear now that it is not possible to continue to take decision on the sol visual aspect of a lesion.

[Ultrasonic imaging of coronary atherosclerosis]. / Imagerie ultrasonore de l'athérosclérose coronaire.

Intra-coronary ultrasonography (ICV) is a technique for in vivo study of the different layers of the arterial wall, the site of atherosclerosis. A qualitative analysis of the composition of the plaque can predict its potential evolutivity (chronic with slow progression or at risk of rupture and causing acute thrombosis) and its response to different types of angioplasty, which could eventually become and essential factor in the choice of appropriate therapeutic strategy. Analysis of the results of B mode ultrasonic scanning has provided correlations with the histological composition of the arterial wall, validating the method and opening up the field of tissue characterisation which hitherto had been limited by the absence of sufficiently reliable, accurate and reproducible quantitative parameters. Magnetic resonance imaging (MRI) is a complementary, non-invasive tool for tissue analysis because its sensitivity to the biophysical and biochemical properties of tissues which makes it a promising method of morphological and functional imaging. Other methods of imaging atheromatous plaques include angioscopy and optic coherence tomography which have also contributed to the improvement in our knowledge of atherosclerosis. These methods of imaging which are slowly overcoming their limitations provide documents which ressemble more and more the histological appearances. Intracoronary ultrasonography is the most promising method and raises hopes that one day we shall be able to predict the outcome and anticipate the risk of rupture of atherosclerotic plaques.

[Intra-coronary ultrasonography during angioplastic procedures]. / Apports de l'échographie endocoronaire en cardiologie interventionnelle.

Thanks to miniaturization and constant improvement of technologies, intracoronary ultrasound (ICUS) progressively takes its place as the best tool to accurately analyze arterial wall structure. However, its routine use during interventional procedures remains limited. ICUS provides precious informations, complementary to angiography, and guide interventional procedures on the basis of a more accurate analyze of the components of the plaque, thus improving their success rate. Since its use favorized the understanding of the different devices mechanisms (angioplasty, stents, directional and rotational atherectomy), ICUS contributed to reduce the incidence of their complications. Many studies have emphasized ICUS interest during these procedures: their results seem to be significantly improved by the way of prompting the operator to adopt an aggressive strategy (additional inflations using high pressures, combination of different techniques...) which tend to reduce the complication rate and the restenosis incidence. Actually, the restenosis rate was in all these studies [OARS (29%), ABACAS (21%) and MUSIC (8.3%)] directly associated to ICUS parameters measured immediately after treatment, particularly the residual plaque burden. Whether its use, that engender substantial cost, cannot be systematic, trained centers will probably demonstrate that a rational and suitable use lead to adopt optimal strategies and achieve improved results.

[Diagnostic value of endocoronary echography]. / Apport diagnostique de l'échographie endocoronaire.

Intracoronary ultrasound allows in vivo examination of the various layers of the wall of arteries affected by atherosclerosis. Its use in the catheterisation laboratory has therefore allowed better understanding of the mechanism of the action of the various angioplasty procedures, allowing better guidance of the indications and better control of these techniques. It also helps to guide these procedures, thereby facilitating an optimal immediate result, which determines the long-term outcome. The characteristics of intracoronary ultrasound (high resolution, proximity of the arterial wall, echogenicity of constituents of the plaque) make it the instrument of choice to study the composition and structure of the plaque, which determine the clinical presentation and active potential, especially the risk of complications (rupture). The development of image and crude acoustic signal processing techniques have improved the performance of the analysis of these documents and raise hopes of one day being able to predict and anticipate plaque rupture.

Reimplantation des incisives superieures apres traumatisme. A propos de 9 observations a la clinique de stomatologie de l'Hopital Le Dantec de Dakar

Dans cet article ; les auteurs nous definissent la reimplantation des incisives superieures apres traumatisme comme une techniquue chirurgicale de traitement conservateur qui consiste a remplacer une dent dans son alveole non encore comblee et dont elle a ete separee momentanement. Ils ont voulu rapporter; dans ce travail; leur experience portant sur 9 patients chez qui ils ont effectue des reimplantations des incisives centrales et laterales traitees . Ils ont enresgistre 13 succes et 4 echecs